Tom Paulson

One of every four deaths from cervical cancer worldwide is a woman in India.

The cancer, which kills 250,000 women every year, is almost always caused by a sexually transmitted virus, human papillomavirus or HPV. There is a vaccine against HPV that studies have shown prevents this infection. India, it turns out, has more than its fair share of HPV and cervical cancer.

In 2009, Seattle-based PATH, with funding from the Bill & Melinda Gates Foundation, launched a project aimed at assisting India with introducing the HPV vaccine.

The sub-headline of the Nature article, “Collapsed trial fuels unfounded vaccine fears,” is perhaps a bit closer to capturing the essence of this tale. But you could also say it was actually the unfounded fears that caused the collapse, which continues to fuel allegations of unethical research. An excerpt:

A scientific investigation has exonerated the vaccines but uncovered a more familiar problem in India: ethical irregularities.

Sounds bad, but I don’t think that was really the main problem here either. The problem, at least insofar as I can tell, is that the scientific and medical community basically sat on the sidelines and hoped to avoid controversy instead of dealing with it head on. Continue reading →

Now, I think these summiteers are all good people and that they probably mean well. But their approach to media reminds me of George Orwell. I got in trouble with them yesterday, simply for asking a question during one of the sessions, and so I decided to write about it.

That didn’t help. I still felt bad. So I was delighted to see that a development and climate change expert I have high regard for, Ed Carr at the University of South Carolina, has come to my defense and in favor of encouraging open dialogue, even with media.

I just attended a session at the Pacific Health Summit that explored the difficulties, and dilemmas, of dealing with public misunderstandings around vaccine safety.

As a journalist, I wanted to join in the discussion. Oops. My bad. As I wrote earlier, there are some who think this meeting is a bit restrictive when it comes to public dialogue. I hadn’t been aware I wasn’t supposed to talk in session.

I was told by summit officials that what I did was inappropriate and a violation of their rules. Sigh ….

Now, the media’s role in communicating — or, unfortunately, often miscommunicating — issues of vaccine risk is of course a big topic here at this exclusive “by-invitation-only” meeting.

It’s a legitimate concern and a real problem. But I don’t think the media’s misbehavior is necessarily at the root of this problem.

A lot of people working in global health talk about the need for “transparency” and public accountability, but what does that mean? Why does it matter?

At the UW’s Institute for Health Metrics and Evaluation, it includes allowing journalists like me to sit in on even the most contentious internal debates and policy discussions. Last week, the IHME held its annual Board of Directors meeting — and I sat in for some of the closing remarks.

I’m highlighting this practice because, as I wrote recently regarding the editor of Lancet boycotting Seattle’s Pacific Health Summit, it still seems acceptable to many in the global health community to exclude the public — or at least keep them at an arm’s length from the true debates and discussions.

Launched in Seattle last year with backing from the Gates Foundation, the Congress’ stated aim is to help scientists inform and complement policy discussions at the Pacific Health Summit — which also gets Gates money and is difficult to summarize as its intended purpose has “evolved” over time. More on that below.

Both meetings this year are focused on vaccines — exploring how best to discover, develop and distribute.

These goals clearly represent a public good.

But their discussions and decision-making are private. Journalists, like me, are allowed in to some (not all) of the discussions. And even for the sessions we are allowed to sit in on, we have to get permission from any attendee before making public what they say.

It’s annoying and cumbersome. I complain about it almost every year and then usually go anyway. I’m not the only one. Here’s a 2009 article by Sandi Doughton on the exclusivity of the new “Davos of global health.”

And last week, I ran into at least one world-renowned expert in global health who said he is refusing to attend the Pacific Health Summit due to this restraint on free and open discussion.

Vaccines are “miracles,” Bill Gates likes to say, because of their power to prevent death and disease so simply and at such a low cost.

At a meeting in London held this week to increase funding for one of global health’s biggest success stories, the Global Alliance for Vaccines and Immunization, governments and international donors agreed to boost funding for the vaccine intiative by $4.3 billion — exceeding GAVI’s request of $3.7 billion.

The new money — most of which came from the British government, the Norwegian government and the Gates Foundation — will allow the vaccine alliance to vaccinate 250 million more children worldwide and prevent at least 4 million child deaths over the next five years.

The funding allows expanding the initiative’s portfolio to include two new vaccines against two big killers, pneumonia and diarrhea.

“For the first time in history, children in developing countries will receive the same vaccines against diarrhea and pneumonia as children in rich countries,” said Bill Gates, co-chair of the Bill & Melinda Gates Foundation. “Together we must do more to ensure that all children – no matter where they live – have equal access to life-saving vaccines.”

In this time of economic recession, when governments and donors are reluctant to even maintain, let alone increase, foreign aid, GAVI’s success at fund-raising is extraordinary.

It’s hard not to be when you look at what this project has accomplished in terms of lives saved.

But there are some questioning whether GAVI is, in fact, saving the most lives possible by getting the biggest bang for the buck. This question was raised at the London meeting and at the press conference.

So let’s ask a few of the tough questions now that the fundraising goal’s been met.

Vaccines are made by drug companies, which tend to want (well, are required) to make money. Yet the goal of GAVI is not supposed to be about helping drug companies make money. The goal is to vaccinate children in poor countries. And poor countries don’t have a lot of money to spare.

The first question:

Does GAVI strike the hardest bargain with drug companies, getting the needed vaccines at the lowest cost? Put another way, is the organization too willing to accept what the drug companies want?

The Wall Street Journal cites a number of organizations who think GAVI has not done enough to reduce prices, is too “cozy” with drug companies and want to see pharmaceutical industry representatives removed from the governing board. Nina Schwalbe, a GAVI official, responded that the alliance has done the best it could to get the industry to reduce vaccine prices and that they need to collaborate with the drug industry.Continue reading →

Thirty years ago, Julie McElrath was a medical resident in Charleston, South Carolina, seeing young patients with rare illnesses, unusual forms of pneumonia or cancer, typically only seen in the elderly with weakened immune systems.

“We were trying to care for these people but we didn’t know what they had,” McElrath said. What they had was AIDS. The epidemic had emerged.

Three decades later, McElrath is one of the world’s leading scientists searching for what many believe is the best, perhaps only, hope of ending the pandemic. A vaccine.

“I do think a vaccine is what we will ultimately need,” she said. Recent studies that have shown that treatment can prevent spreading the infection to others is tremendous news, she said, but the logistics and expense of making that happen are daunting.

HIV Trials Network, Fred Hutchinson

Julie McElrath

Today, in her Seattle lab, the HIV Trials Network operated by the Fred Hutchinson Cancer Research Center, she and her colleagues will open precious vials containing white blood cells collected from thousands of Thai research volunteers.

Not that long ago, many had given up on ever finding a vaccine against HIV.

Then, in late 2009, the Thai Prime-Boost vaccine trial (technically known as RV 144) stunned the skeptics, well, okay, almost everybody, by demonstrating that a vaccine could prevent infection. It wasn’t enough protection, but it was protection.